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AMA Comments on ACA Implementation Regulations

As implementation of Affordable Care Act (ACA) provisions proceeds, the AMA is rapidly responding to regulatory proposals being issued by various federal agencies. Following is a summary of key regulations and opportunities for public comment that have been issued so far, with links to relevant federal documents and comments submitted by the AMA.

Administrative Simplification

Meaningful administrative simplification would result in significant savings and benefits to physicians and the health care delivery and payment system.

Request for comments - April 17, 2012

Request for comments - January 10, 2012

AMA comments
May 17, 2012 comment letter to CMS

March 7, 2012 comment letter to HHS

Antitrust relief and removal of other legal barriers
Basic Health Program

The ACA offers states the option of implementing the Basic Health Program (BHP), which provides states 95 percent of what the federal government would have spent on tax credits and subsidies for out-of-pocket costs for adults with incomes between 133 and 200 percent of the federal poverty level (FPL), and for legally resident immigrants with incomes below 133 percent FPL who do not qualify for Medicaid. Individuals eligible for the BHP cannot receive subsidized coverage in the state exchange.

Request for comments - September 14, 2011

AMA Comments
October 31, 2011 comment letter

Consumer Health Plan Appeals
Consumer Operated and Oriented Plan Program

Section 1322(a) of ACA requires the Secretary of Health and Human Services (HHS) to establish the Consumer Operated and Oriented Plan (CO-OP) program. Operating as nonprofit organizations, CO-OPs will compete directly with established nonprofit and profit-seeking insurers.

Request for comments - July 20, 2011

Request for comments - February 2, 2011

AMA comments
September 15, 2011 comment letter to HHS

March 4, 2011 comment letter to HHS

Coverage of Preventive Services

Insurers are required to cover certain evidence-based preventive services at no cost to plan enrollees.

Interim Final Rule - July 19, 2010

AMA Comments
September 17, 2010 comment letter to HHS

Dependent Coverage of Children Under Age 26

Individual and new employer health plans are required to make dependent coverage available until a child reaches the age of 26.

Interim Final Rule May 13, 2010

AMA Comments
AMA did not comment

Essential Health Benefits

Effective in 2014, all qualified health benefits plans, including those offered in exchanges and in the individual and small group markets outside of exchanges, with the exception of grandfathered individual and employer-sponsored plans, will be required to offer at least the essential health benefits package.

Request for Comments, November 26, 2012

Request for Comments, December 16, 2011

Request for Comments, December 2010

AMA Comments
December 21, 2012, AMA Comments to CMS

January 14, 2011, AMA Comments to HHS

January 14, 2011, AMA Statement to IOM

Expanded Form 1099 Reporting Requirements

Effective for payments made after December 31, 2011, section 9006 of the ACA (incorporated as section 6041 of the internal Revenue Code) requires all businesses that pay any amount greater than $600 during the year to corporate and non-corporate providers of property, goods and services to file an information report--Form 1099--with the IRS.

Request for Comments - July 19, 2010

AMA Comments
September 29, 2010 comment letter to IRS

"Grandfathered" Health Plans

Individuals and businesses may keep their current health plans during the transition to making coverage available through health insurance exchanges.

Interim Final Rule - June 17, 2010

AMA Comments
August 12, 2010 comment letter to HHS

Health Insurance Exchanges
HHS Initial Core Set of Health Quality Measures for Medicaid-Eligible Adults

Sec. 2701 of ACA requires the Secretary of HHS to develop an initial core set of health quality measures recommended for Medicaid-eligible adults.

Request for comments - December 30, 2010

AMA Comments
February 24, 2011 comment letter to HHS

HHS National Health Care Quality Strategy and Plan

Sec. 3011 of ACA requires the HHS Secretary to establish and deliver a National Health Care Quality Strategy and Plan to Congress by January 1, 2011.

AMA Comments
October 15, 2010 comment letter to HHS


The ACA extends and simplifies Medicaid eligibility beginning in 2014 to cover all individuals under age 65 with incomes below 133 percent of the Federal Poverty Level; replaces the current standards and methods for evaluating income eligibility, and simplifies eligibility determination and enrollment and re-enrollment procedures.

Request for comments – January 22, 2013

Request for comments - August 17, 2011

AMA Comments
February 21, 2013 comment letter

October 31, 2011 comment letter

Medical Loss Ratios

Health insurers offering individual or group coverage will be required to submit annual reports on the percentages of premiums spent on health care and quality improvement, and to provide rebates to enrollees if this spending does not meet minimum standards.

Request for Comments - April 7, 2011

Request for Comments - December 1, 2010

Request for Comments - April 14, 2010

AMA Comments
June 3, 2011 AMA comment letter to CMS Administrator Berwick

February 28, 2011 supplemental comments to HHS

January 31, 2011 comment letter to HHS

June 20, 2010 comment letter to NAIC

June 7, 2010 comment letter to NAIC

May 17, 2010 comment letter to NAIC

May 13, 2010 comment letter to HHS

Medicare and Medicaid Program Enrollment and Documentation Requirements for Ordering and Referrals

Physicians and eligible professionals who order and refer covered items and services for Medicare beneficiaries are required to be enrolled in Medicare. Providers and suppliers participating in the Medicare program must also provide documentation on referrals to programs at high risk of waste and abuse.

Final Rule - February 2, 2011

Interim Final Rule - May 5, 2010

AMA Comments
March 30, 2011 comment letter to HHS
May 28, 2010 comment letter to HHS
May 6, 2010 comment letter to HHS

Payment Adjustment for Provider-Preventable Conditions (PPCs)

Section 2702 of ACA directs the Secretary of HHS to identify current state practices that prohibit payment for Health Care-Acquired Conditions (HCACs) and incorporate the practices identified, or elements of such practices, which the Secretary determines appropriate for application to the Medicaid program in regulations to be effective as of July 1, 2011.

Request for comments - February 17, 2011

AMA comments
March 18, 2011 comment letter to HHS

Physician-Owned Hospitals

This proposed rule includes provisions to implement new limitations on certain physician referrals to hospitals in which they have an ownership or investment interest.

Interim Final Rule - August 3, 2010

AMA Comments
August 31, 2010 comment letter to HHS

Preexisting Condition Exclusions, Lifetime and Annual Limits, Rescissions, and Patient Protections

Preexisting condition exclusions or denials, lifetime dollar limits on benefits, and rescissions are banned except in clear cases of fraud. Patients are also protected with respect to choice of health care professionals and no prior authorization requirements for emergency care, including services provided out-of-network.

Interim Final Rule - June 28, 2010

AMA Comments
August 27, 2010 comment letter to HHS

Premium Review Process

The Secretary of HHS is required to work with states to establish an annual review of unreasonable insurance rate increases, to monitor premium increases, and to award grants to states to carry out their rate review processes.

Request for Comments - December 23, 2010
Request for Comments - April 4, 2010

AMA Comments
February 22, 2011 comment letter to HHS
June 30, 2010 comment letter to NAIC

Public Reporting and Data Release
Risk Adjustment, Reinsurance, and Risk Corridors

The ACA requires the creation of programs for risk adjustment, transitional reinsurance, and temporary risk corridors to mitigate the impact of potential adverse selection and stabilize premiums in the individual and small group markets as insurance reforms and the exchanges are implemented.

Request for comments - July 15, 2011

AMA Comments
October 31, 2011 comment letter

Helpful ACA Implementation Links